Ahmadzia, HK

Dazelle, W

Litman, E

Sterling, E

English

George Washington University: Health Sciences Research Commons (HSRC)

An update to tranexamic acid (TXA) trends in the United States during the peripartum period, 2016 – 2021Sterling E1, Litman E 1, Dazelle W 1, Ahmadzia HK21 George Washington University, School of Medicine and Health Sciences, Washington, DC2 Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, George Washington University, Washington, DCGiven the new studies and guidelines on TXA usage, we aimed to evaluate the change in usage of TXA during delivery both temporally and geographically within the United States. Secondary outcomes included perinatal outcomes.• Results from the 2016 World Maternal Antifibrinolytic (WOMAN) trial found that patients who received tranexamic acid (TXA) during delivery had significantly lower rates of death and hysterectomy. • In 2017, ACOG endorsed the consideration of TXA usage when traditional uterotonics fail during postpartum hemorrhage (PPH). Since then, TXA usage has become more mainstream for the treatment of PPH. • New studies using TXA have both begun and been completed, including the TRAAP2 trial, MFMU TXA Study, WOMAN-2 Trial, and E-MOTIVE trials• Design: Retrospective cohort data• Population: Admissions for delivery from July 2019 to June 2021 who delivered via vaginal or cesarean delivery from 20 hospitals within the Universal Health Services (UHS) network• Rates of TXA usage were compared over time between the east, central, and western regions of the United States• Additional nationwide inpatient data was extracted using Cerner Real World DataTM from 2016-2020Poster # 71• As research and guidelines are updated with TXA as a treatment for postpartum hemorrhage, TXA usage has continued to increase nationally, especially in the western region of the United States. • Patients who received TXA did not have an increased risk of venous thromboembolism.• Of 50,150 deliveries, 1,580 (3.2%) patients received TXA during the 2-year study period. • Patients who received TXA during delivery were more likely to have a history of postpartum hemorrhage (P < 0.0001), chronic hypertension (P < 0.0001), preeclampsia (P < 0.0001), and/or diabetes (P = 0.004).• Of the women who received TXA, 53.2% (840/1580) had an estimated blood loss (EBL) of less than 1000 mL. • Perinatal outcomes, such as blood transfusion, EBL > 1000 mL, ICU admission, disseminated intravascular coagulation, placental abruption, and placental accreta significantly increased the odds of TXA use.• Women who received TXA did not have an increased likelihood of venous thromboembolism compared to those who did not receive TXA (8 (0.5%) vs. 226 (0.5%), P = 0.774).Table 1. Patient characteristics in those with TXA and those without TXA (UHS)Key FindingsFigure 2. Rate of TXA use from 2019-2021 by region (UHS)Figure 1. Births with TXA use by zip code region (Cerner Real-WorldTM )• Cerner Real World DataTM encounters may include pharmacy, clinical and microbiology laboratory, admission, and billing information from affiliated patient care locations. All admissions, medication orders and dispensing, laboratory orders and specimens are date and time stamped, providing a temporal relationship between treatment patters and clinical information. Cerner Corporation has established Health Insurance Portability and Accountability Act-compliant operating policies to establish de-identification for Cerner Real-World.• Ahmadzia, H. K., Hynds, E. B., Amdur, R. L., Gimovsky, A. C., James, A. H., & Luban, N. (2020). National trends in tranexamic acid use in the peripartum period, 2015-2019. Journal of thrombosis and thrombolysis, 50(3), 746–752. https://doi.org/10.1007/s11239-020-02141-4• U.S. ZIP codes: Zip code map and ZIP code. United States Zip Codes. (n.d.). https://www.unitedstateszipcodes.org/With TXA (n = 1,580)Without TXA (n = 49,470)PDemographic variablesAge 29.6 ± 6.14 28.6 ± 5.87 0.01Body mass index 35.3 ± 24.3 36.2 ± 265.9 <.0001Race <.0001White 679 (42.9%) 25,371 (51.3%)Black 291 (18.4%) 7,246 (14.6%)Asian 96 (6.1%) 2,179 (4.4%)Other/unknown 514 (32.5%) 14,674 (29.6%)Sector <.0001East 251 (15.9%) 9,631 (19.5%)Central 292 (18.5%) 13,990 (28.3%)West 1,037 (65.6%) 25,849 (52.3%)Maternal medical conditionsChronic hypertension 51 (3.2%) 875 (1.8%) <.0001Diabetes 93 (5.9%) 2,170 (4.4%) 0.004Pregnancy-related variablesDelivery type <.0001Vaginal 715 (45.3%) 32,057 (64.8%)Cesarean 854 (54.1%) 17,104 (34.6%)VBAC 11 (0.7%) 309 (0.6%)Gestational diabetes 144 (9.1%) 3,644 (7.4%) 0.009History of PPH 320 (20.3%) 1,827 (3.7%) <.0001Preeclampsia 60 (3.8%) 1,151 (2.3%) <.0001Placenta previa 39 (2.5%) 297 (0.6%) <.0001Labor-related variablesGestational age, stratified <.000128-34 weeks 52 (3.3%) 897 (1.8%)34 1/7 – 36 6/7 183 (11.6%) 3,384 (6.8%)> 37 weeks 1,330 (84.2%) 44,300 (89.6%)Antibiotics 1,323 (83.7%) 30,034 (60.7%) <.0001Platelets < 150,000 201 (12.7%) 3,920 (7.9%) <.0001Hematocrit < 32% 248 (15.7%) 6,539 (13.2%) 0.004Mg for neuroprotection 213 (13.5%) 2,326 (4.7%) <.0001Misoprostol 928 (58.7%) 7,968 (16.1%) <.0001Oxytocin 1,544 (97.7%) 46,396 (93.8%) <.0001Artificial rupture of membrane 224 (14.2%) 6,499 (13.1%) 0.229Spontaneous rupture of membrane77 (4.9%) 2,961 (6.0%) 0.066Male baby 788 (49.9%) 24,970 (50.5%) 0.638Perinatal outcomes OR 95% CI P aORa 95% CI aPBlood transfusion 12.54 9.97-15.78 <.0001 7.46 5.79-9.63 <.0001EBL ≥ 1000 mL 1.08 1.07-1.10 <.0001 1.07 1.06-1.09 <.0001ICU admission 16.41 8.38-32.13 <.0001 4.95 2.29-10.69 <.0001Chorioamnionitis 2.69 1.88-3.84 <.0001 2.58 1.78-3.74 <.0001DIC 83.91 22.24-316.58 <.0001 16.66 3.55-78.36 <.0001Placental abruption 2.17 1.47-3.22 0.0005 1.76 1.17-2.64 0.006Placental accreta 22.57 11.61-43.86 <.0001 10.54 5.07-21.89 <.0001NICU admission 2.50 2.15-2.91 <.0001 1.82 1.55-2.15 <.0001Vacuum-assisted delivery0.98 0.77-1.23 0.84 1.04 0.82-1.32 0.73Forceps-assisted delivery1.85 1.11-3.07 0.029 1.62 0.96-2.73 0.069Eclampsia 1.00 0.37-2.71 0.99 0.67 0.24-1.87 0.45HELLP syndrome 6.65 3.87-11.43 0.002 3.07 1.72-5.49 <.0001H1 = January – JuneH2 = July – December Zip Code Region% Births with TXA Use by Region0 1.35%1 17.65%2 6.27%3 0.12%4 2.34%5 5.41%6 5.50%7 4.40%8 39.48%9 12.81%4.66%TotalStudy DesignObjectiveIntroduction ResultsConclusionsReferencesTable 2. Risk factors predicting odds of TXA use (UHS)

An update to tranexamic acid (TXA) trends in the United States during the peripartum period, 2016 – 2021

https://hsrc.himmelfarb.gwu.edu/cgi/viewcontent.cgi?article=1261&context=gw_research_showcase

An update to tranexamic acid (TXA) trends in the United States during the peripartum period, 2016 – 2021

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